The Role of the Obesity Medicine Physician

| March 26, 2014

This column is dedicated to providing information on the medical management of obesity, which includes diet, exercise, behavioral change, and medication.

Column Editors: Craig Primack, MD, FACP, FAAP, Medical Bariatrician/Certified Medical Obesity Specialist/Co-Medical Director, Scottsdale Weight Loss Center PLLC, Scottsdale, Arizona; and Wendy Scinta, MD, MS, FAAFP, Medical Director, Medical Weight Loss of NY, BOUNCE Program for Childhood Obesity, Fayetteville, New York; Clinical Assistant Professor of Family Medicine, Upstate Medical University, Syracuse, New York

This month: The Role of the Obesity Medicine Physician: An Interview with Robert F. Kushner, MD, and Wayne English, MD, FACS

Dr. English is Co-Chair of the Committee on Metabolic and Bariatric Surgery (CMBS) Standards Subcommittee. He is the Clinical Assistant Professor, Department of Surgery, Michigan State University College of Human Medicine and Medical Director, Bariatric & Metabolic Institute, Marquette General Hospital—A Duke LifePoint Hospital, Marquette, Michigan.

Robert F. Kushner, MD, is Chair of the American Board of Obesity Medicine, and Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Interviewed by Dana Brittan, MBA
Dana Brittan is Executive Director, American Board of Obesity Medicine, Denver, Colorado.

Bariatric Times. 2014;11(3):28–29.

American Board of Obesity Medicine (ABOM) certification signifies excellence in the practice of obesity medicine. It distinguishes a physician as having achieved a higher level of competency and understanding in obesity care by completing specialized education. Obesity medicine physicians meet rigorous qualification and assessment requirements.

Obesity medicine Diplomates are committed to providing effective, evidence-based therapy for patients who are overweight or obese. They recognize the need for a comprehensive approach that considers the multiple factors contributing to obesity including lifestyle, medical, and surgical treatment options.

Brittan: What is an obesity medicine physician?

Dr. Kushner: The board of directors for the American Board of Obesity Medicine (ABOM) developed a description that defines the specialty. The definition is as follows.

An obesity medicine physician is a physician with expertise in the sub-specialty of obesity medicine. This sub-specialty requires competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity.

The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy. He or she also utilizes a comprehensive approach, and may include additional resources such as nutritionists, exercise physiologists, psychologists, and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre-, peri-, and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity.

Brittan: What unique skill set can the obesity medicine physician bring to the bariatric surgical setting?  

Dr. Kushner: Board certified physicians have a demonstrated competency in all aspects of obesity care. For patients considering bariatric surgery, the obesity specialist leads a team of other healthcare providers, including a registered dietitian, mental healthcare provider, nurse practitioner, or physician assistant in guiding the comprehensive preoperative assessment and managing the patient through the perioperative and postoperative experience.

Brittan: What impact can the obesity medicine physician have on patient outcomes?

Dr. Kushner: Assessment and management of obesity-associated medical conditions is important to reduce in-hospital and long-term outpatient complications. Chronic medical conditions, such as diabetes, hypertension, obstructive sleep apnea, and depression require ongoing monitoring and medication adjustment. Additionally, bariatric surgical patients are at risk for development of multiple nutritional deficiencies that require similar vigilance.

Northwestern University Feinberg School of Medicine in partnership with Northwestern Memorial Hospital developed a comprehensive obesity care program in 1998 that coordinated medical and bariatric surgical services within one “virtual” center. Thus, patients seeking comprehensive obesity care services are seen by a multidisciplinary team that provides a range of treatments, including lifestyle management, pharmacotherapy, and bariatric surgery. Since obesity is viewed as a chronic relapsing disease, patients benefit from the integration of treatment approaches and expertise.

Brittan: Have you had the experience of working with an obesity medicine physician in your surgical practice?

Dr. English: Yes, it helped to significantly improve the patient experience and the quality of care I provide for my patients.

Brittan: In your personal experience, how has working with an obesity medicine physician complimented your surgical care?  

Dr. English: Working with an obesity medicine physician has complimented my surgical care in many ways.

First, it allows for continued counseling for patients who express interest in surgery, but are not fully committed. It also expands the range of available obesity treatment options, especially for patients who do not meet criteria for metabolic and bariatric surgery. This may include simple nutritional and exercise counseling or prescribing weight loss medications.

Working with an obesity medicine physician provides further education for patients who do not yet fully understand that metabolic and bariatric surgery is a viable treatment option. Having an obesity medicine physician expedites preoperative medical assessments for optimizing patient’s comorbidities; (i.e., working with patients to reduce hemoglobin A1c [Hb A1C] to an acceptable level before scheduling surgery).

Another advantage is being able to complete “softer” system clearances when indicated; therefore, specific specialty evaluations may be avoided. However, patient referrals can be made more efficiently if “hard” specialty clearances are required.

Obesity medicine psysicians also offers support groups and workshops for patients (e.g., “Am I Hungry” and “Back on Track”) and may allow for easy referrals (medical to surgical and vice versa). Patients who have failed conventional treatment options for medical weight management can be referred for surgery. Surgery patients who have regained weight can be referred to the obesity medicine physician to develop a comprehensive intensive nutritional and exercise counseling program and to consider starting weight loss medications. Lastly, patients with contraindications for surgery can be referred to the obesity medicine physician for ongoing care

Brittan: What are the advantages of working with an obesity medicine physician?   

Dr. English: In general, patients in the community feel more self-assured when seeing a board certified physician. A board certified obesity medicine physician working in my practice enhances the perception within the community that we are fully committed to providing a high-quality comprehensive approach to obesity treatment.
It helps create better awareness and acceptance in the community that obesity is a complex disease that requires treatment by a physician who has completed specialty training. It can also help to fulfill medical weight management criteria required by many insurance companies.

Brittan: Are there any clinical findings or evidence-based research supporting the value of obesity medicine physicians and bariatric surgeons working together?

Dr. Kushner: All bariatric surgery guidelines call for the inclusion of a multidisciplinary team in the evaluation and long-term follow up of patients. The National Institutes of Health (NIH) Development Conference from 1991 stated “Patients who are candidates for bariatric procedures should be selected carefully after evaluation by a multidisciplinary team with access to medical, surgical, psychiatric, and nutritional expertise.[1] ” More recently, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) states that “postoperative rehabilitation and long-term follow up includes dietary, exercise, and psychological counseling.”[2] The obesity medicine physician holds an integral position in coordinating the nonsurgical care.

Brittan: In working with an obesity medicine physician, are you able to spend more hours in the operating room? Is there a natural division of labor?

Dr. English: Routine postoperative follow-up visits can be seen by the obesity medicine physician and referred to the surgeon when indicated. They may increase physician availability to office and hospital staff for triaging patient concerns, allowing surgeons to concentrate more appropriately on duties in the operating room.

When a surgeon is unavailable, the obesity medicine physician can perform preliminary evaluations and expedite urgent care for patients when necessary.

Obesity medicine physicians can evaluate patients with weight regain who are requesting revision surgery.  They can rule out mechanical issues that may require surgical intervention; if surgical intervention is needed, patients can be prepared for surgery expeditiously.
Obesity medicine physicians can also provide care to patients who require more rigorous follow-up, such as managing patients with vitamin and mineral deficiencies after surgery.

Brittan: As a bariatric surgeon, why have you chosen to serve on the ABOM Board of Directors?

Dr. English: As a surgeon, I wanted to further enhance my understanding of obesity medicine. I felt very secure about my surgical knowledge, but knew I had some significant shortcomings with the medical aspect of treating obesity.

Being a member of the ABOM Board of Directors has allowed me to validate what I considered best practice, but more importantly it provided me with better insight on the importance of working closely with my medical colleagues in order to provide a broad range of treatment options.

In addition, the requirement of writing items for the ABOM certification exam forced me to review obesity-related topics more critically. As a result, I have gained a more comprehensive understanding of the nuances of obesity treatment and developed a much greater degree of respect and appreciation for my medical colleagues who commit themselves to providing high-quality obesity care.

Brittan: What is the value of working with an ABOM Diplomate specifically?  

Dr. Kushner: The “surgical-medical” physician team is well established in the healthcare setting. Using similar models as “cardiologist and cardiac surgeon” or “nephrologist and kidney transplant surgeon,” the “obesity medicine specialist and bariatric surgeon” can provide exceptional care to patients seeking long-term and durable surgical treatment for their obesity and associated medical problems.

Brittan: In what way are you hoping ABOM Diplomates will impact the bariatric surgery setting?

Dr. English: In the Upper Peninsula (UP) of Michigan, we are in the process of developing a primary care physician obesity collaborative that will improve the scope of obesity treatment care available to the outlying communities. I would like to see this develop on a national scale.
Primary care physicians will be encouraged to become board certified in obesity medicine and will participate in regularly scheduled meetings to coordinate obesity care throughout the UP.

With over two-thirds of the population being overweight or obese, establishing a network of obesity medicine physicians in the community will provide a better continuum of care utilizing best practice for obesity treatment.

Brittan: Drs. English and Kushner, thank you for taking the time to speak with me.

References
1.    The National Institutes of Health (NIH) Consensus Development Program: Gastrointestinal Surgery for Severe Obesity. Consensus Development Conference Statement March 25–27, 1991. http://consensus.nih.gov/1991/1991gisurgeryobesity084html.htm. Accessed 3/6/14.
2.    Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Standards and Pathways Manual. http://www.mbsaqip.info/?page_id=54. Accessed 3/6/14.

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Category: Medical Methods in Obesity Treatment, Past Articles

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